Provider Demographics
NPI:1619551751
Name:DUKACH, JULIA (RDH)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DUKACH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 W 5TH ST APT 9R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3871
Mailing Address - Country:US
Mailing Address - Phone:631-933-5979
Mailing Address - Fax:
Practice Address - Street 1:3 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7969
Practice Address - Country:US
Practice Address - Phone:646-859-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031327124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist